Application for A Full Vector Control Worker Certificate

This form may take you 5 minutes to fill in. You will need the following information to fill in the form:
Applicants Personal Particulars
Applicants Present Employer Particulars (if applicable)

Please complete the Application Form and submit it with the following documents to:
Environmental Health Department
National Environment Agency
40 Scotts Road #21-00, Environment Building
Singapore 228231
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Two recent NRIC-sized photographs (Please write your name and NRIC No. on the back of the photographs).
A copy of your NRIC/Employment Pass/Work Permit (Front and back).
A copy of your highest educational qualification.
A copy of the Joint ITE NEA Certificate in Pest Control.
A fee of $22 for a full worker certificate (valid for 36 months) to be paid by cheque, made payable to National
Environment Agency. (Please write your name and NRIC No. on the back of the cheque)

Part 1 Personal Particulars of Applicant

Name of Applicant:
NRIC / FIN No.*:
Employment Pass / Work Permit No. (if applicable) *:
Home / Mailing address:
Home / Handphone No.:
Citizenship (Singapore Citizen / Permanent Resident /Others):
Name and Address of Present Employer:

Part 2 Declaration By Applicant

I declare that the information submitted by me above is true to the best of my knowledge and belief, and that I have not
willfully suppressed any material facts. I am fully aware that any suppression of material facts and/or false declaration by me
may result in this application being refused or, if approved, in the suspension or cancellation of my licence under Section 31
of the Control of Vectors and Pesticides Act.
The National Environment Agency (NEA) collects personal information to carry out its various functions and duties under the
National Environment Agency Act (Cap 195) including the implementation of environmental and public health policies in
Singapore and any other related purposes. I hereby consent to NEAs use of the information provided by me in the course of
any application I have made to the NEA, to facilitate the processing of such application for such purposes. I hereby further
consent to NEA sharing the information in such application with other Government agencies, or non-government entities
authorized to carry out specific government services, unless prohibited by legislation.

Applicants Signature

Date

*Please delete as appropriate.

For official use only:
Status: Approved / Rejected

Name of Manager/EHE: ____________________________

Date:

Remarks:

_______________

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Version 6 / 1 Feb 13